Westwood Elementary School Scholarship

DUE in the WHS Counseling Office Friday, April 21, 2017 Date Received_______________________

Westwood Elementary School Scholarship

Waynesboro, Virginia

Date of this School Year_________________

NAME_________________________________________________ PHONE________________________

(Last) (First) (Middle)

PERMANENT MAILING ADDRESS _________________________________________________________

_________________________________________________________

DATE OF BIRTH ____________________________

PARENTS’ NAMES _____________________________ ___________________________________

ADDRESS _____________________________ ___________________________________

_____________________________ ___________________________________

PHONE _____________________________ ___________________________________

PERSONAL STATEMENT

1. How did Westwood prepare you for further education?

__________________________________________________________________________

2. How did Westwood assist in building your character?

__________________________________________________________________________

DATE OF YEARS AT WESTWOOD _____________________________________________

GPA (8th grade to present) __________________________________________________

REFERENCES

Please give three (3) references that the Committee, with your permission, may contact (at least one being

a teacher, school counselor, or administrator). DO NOT give names of family members.

Name ________________________________________ Phone ______________________________

Address _______________________________________ Occupation __________________________

_______________________________________

Name ________________________________________ Phone ______________________________

Address _______________________________________ Occupation __________________________

_______________________________________

Name ________________________________________ Phone ______________________________

Address _______________________________________ Occupation __________________________

_______________________________________

List all extracurricular activities (school and community) that you have participated in since entering

high school:

_________________________________________________________________________________________

Name and complete mailing address of the school to which you have been accepted:

____________________________________________________________

I hereby apply for the Westwood Elementary School Scholarship of $ __________________, understanding

that this scholarship is to be awarded on the basis of scholarship and citizenship. The money awarded will

be sent directly to the college to which you have been accepted.

Signature ____________________________________

Date ________________________________________